| Background:The heritage of famous elder Traditional Chinese Medicine doctor’s clinical experience is a mission in current field of TCM. To strengthen the research on the inheritance of famous elder TCM doctor’s experience, national "fifteen" science and technology support program brings "the research on famous elder TCM doctor’s academic thoughts and experience inheritance" into the research plan. Professor Shen Shuwen (Prof. Shen) is a second grade professor in Shaanxi University of Traditional Chinese Medicine, one of the first batch of famous TCM doctors in Shaanxi province and the tutor of inheritance of academic experience of TCM experts in the national fourth and fifth batch. He has a great attainment in TCM theory and has rich clinical experience. As an inheritor of his academic experience, I will research and organize his experience in treating Chronic Atrophic Gastritis(CAG), and study his medical records of treatment of precancerous lesion of gastric cancer (PLGC) induced by CAG through data mining method.Purposes:This thesis systematically summarizes the academic thoughts and clinical experience of Prof. Shen in treating CAG in order to inherit his clinical therapeutic experience of CAG and discusses the academic thoughts in academic level. This research will reveal the scientific connotation of Prof. Shen’s experience on syndrome differentiation and treatment of PLGC with satisfactory therapeutic effects and helpfully explore the heritage of academic experience further by means of data mining research on 120 PLGC cases induced by CAG.Methods:The research part of clinical experience and academic thoughts are mainly adopted by "comprehension approach":understanding the ideological origins, academic thoughts and clinical experience of tutor in the treatment of CAG by studying the thesis of tutor, seeing that how tutor treats the diseases, requiring answers from tutor, and organizing the medical records of tutor, etc. and organizing, condensing and hackling them to achieve the learning purposes of digging, mastering and inheritance. The research methods of data mining research on clinical cases of PLGC as follows:first, set up the Unitized Clinical Medical Records Management System of Famous TCM Doctor’s Syndrome Differentiation databank, and it will be the carrier of collecting records and statistics management of Prof. Shen’s clinical cases. The research will study the tutor’s diagnosis and treatment of 120 PLGC cases induced by CAG in recent three years, through identifying and picking up the elements of syndrome such as the location of disease, nature of disease, tendency of disease, etc, then use terminology normalization to form unit diagnosis of syndrome and do digital mining analysis of its name of disease, location of disease, nature of disease, syndrome type, treatment, medication frequency, medicine classification, composition of prescription and therapeutic effect indexes, etc. in order to reveal the scientific connotation and clinical thinking feature of its experiential efficacy.Results:Findings of academic experience:1. Prof. Shen’s academic thoughts of syndrome differentiation and treatment of CAG come from Neijing, which highlights the idea that the earth is the source of all things, and draws from the various schools. Based on Zhang Zhongjing’s therapy, Banxia Xiexin Decoction is often used to eliminate cold-heat intermingled fullness of CAG patients and Huangqi Jianzhong Decoction is used to relieve patients’stomachache with syndrome of deficient cold of spleen and stomach. According to Li Dongyuan’s treatment, patients with distention and fullness and poor appetite often take Zhishi Xiaopi Bolus to receive and transport while patients with bloated stomach and diarrhea use Buzhong Yiqi Decoction to tonify spleen and rise yang. Based on Ye Gui’s experience, patients with gastric upset often take Yangyin Yiwei Decoction to nourish yin and stomach. Shixiao Powder and Danshen Decoction are mainly used to relieve patients’stomachache with blood stasis. Prof. Shen accurately masters these prescriptions by getting the essence of He Lun’s prescription, and focuses on mutual assistance of absorption and digestion of spleen and stomach, comprehensive use of ascending and descending, interdependence between drying and moistening when composing prescriptions.2. Prof. Shen’s clinical thinking in treating CAG:When he was making a diagnosis, the reference standard were medical history and four diagnosis, especially tongue diagnosis and enquiry. He adopts the "discriminating the root cause and symptoms of a disease" clinical thinking mode and reveals that syndrome structures of CAG are mainly the deficiency-excess correlation syndrome.3. Prof. Shen’s academic viewpoints and clinical experience in treating CAG:he puts forward a pathogenesis theory of co-existence ofLdeficiency and stagnation, the "stagnation" including qi stagnation, dyspepsia, damp stagnation and collateral stagnation and the "deficiency" containing qi deficiency and yin deficiency. He follows the rule of flourishing deficiency to cure the disease and dredging stagnation to cure the syndrome and combines both of them. The opinion of enriching stomach-yin to harmonize stomach qi is based on the feature of moistening stomach to descend qi. Prof. Shen raises a pathogenesis theory of toxin congestion and deficiency of both yin and qi and specializes in the treatment of PLGC by tonifying qi and nourishing yin and detoxifying and removing stagnation. His experience and characteristics about using medicine and giving prescription are based on the essence of prescriptions. Based on the functional and pathogenic characteristics of spleen and stomach, the combination of receiving and transporting is to regulate the dysfunction of receiving and transporting of spleen and stomach, adopting both ascending and descending strategies is to dredge qi stagnation, using both moistening and drying methods is to soothe spleen dampness and stomach dryness. In a word, Prof. Shen uses medicine flexibly, masters the ancients’experience and innovates proved prescription.Data mining research results of clinical PLGC cases:these clinical medical data indicate that distention and fullness are the main symptoms of PLGC, accounting for 38.33% and 20.82% respectively. At the initial diagnosis of PLGC, the main clinical symptoms were, in order, distention and fullness, flatulence, gastric upset, epigastric pain, dry mouth, stomach burning, and there is no difference between CAG’s basic pathological changes. Disease location can be involved stomach, spleen, liver, gallbladder, abdomen, kidneys and so on, stomach accounting for 90% and spleen for 76.67%. Nature of disease has excess of pathogenic factor and deficiency of genuine qi. Excess pathogenic syndrome includes qi stagnation (qi inverse), toxin stagnation, damp heat, cold coagulation, blood stasis and phlegm dampness, especially toxin stagnation, qi stagnation and damp heat. Deficiency syndrome contains stomach-yin, spleen-qi, epigastric-yang, liver-blood and kidney-yang, especially stomach-yin deficiency and spleen-yang deficiency. According to the statistics of nature of disease, toxin stagnation, qi or yin deficiency and qi stagnation are the principal symptoms in the initial diagnosis and the further consultation, qi or/and yin deficiency accounting for 63.14% and toxin or/and stagnation accounting for 58.62%. Course of disease often has dynamic characteristics of excess syndrome by deficiency and deficiency syndrome by excess, so excess and deficiency both appear in the same disease, which are called the deficiency and excess correlation syndrome by the tutor. The clinical syndromes of 120 PLGC cases contain 14 types. The single syndrome only has 6 types accounting for 23.73% while the deficiency and excess correlation syndrome accounts for 76.27%. All of these reveal that PLGC has characteristics of deficiency in origin and excess in symptom and connection of excess and deficiency, of which deficiency of both qi and yin and toxin and blood stasis take a great proportion in the PLGC(35.30%). There are 11 therapeutic methods for PLGC, including detoxifying and dredging stagnation method (54.68%), tonifying qi and nourishing yin method(42.61%) and harmonizing the stomach and down bearing qi method(35.14%). Among the 120 clinical cases,1218 prescriptions are collected, the cumulative medication frequency is 15398, the average medication number in each prescription is 12.6 herbs and the medication frequency of 96 herbs is more than 10. Medicines for detoxifying, removing blood stasis, tonifying qi and nourishing yin are much more used while medicines for regulating qi take a great proportion in the medication use. Medicines used more than 280 are, in order, Maidong, Banzhilian, Shihu, Ezhu, Taizishen, Banxia, Zhishi, Huanglian, Tengligen, Ciweipi, Baizhu, Foshou, Xuanfuhua, Huangyaozi, Wuzhuyu, Danshen. The core medicines use of detoxifying and anticancer are Ezhu, Gouju, Banzhilian, Tengligen, Shancigu, Huangyaozi.This study performs a statistical analysis on the prescription composition of common syndrome types of PLGC in order to reveal the rule of prescription and medication use. Statistical results of this study show that belching symptom of patients is improved after the treatment (P<0.05). Meanwhile, other main symptoms and the total scores of symptoms are even (P<0.01). So, the results are statistically significant between before treatment and after treatment. The effective rate of TCM syndrome differentiation and treatment is up to 94.17%. Patients are markedly relieved after treatment in these aspects--endoscopic lesions, gastric mucosal inflammation grading, atrophy, intestinal metapiasia and dysplasia. The pathologic scores of gastroscopy and biopsy are even between before treatment and after treatment (P<0.01), so there are statistically significant differences. PLGC with Hp infection is up to 60.83%. Fortunately, the TCM syndrome differentiation and treatment has a higher eradication rate(84.93%). Only 2 cases of 120 clinical cases turn to cancer. Syndrome differentiation and treatment is very effective in treating PLGC and the total effective rate of treatment is up to 86.67%. The indexes of urine routine, blood routine, stool routine, kidney function, liver function and electro- cardiogram were not changed significantly.Conclusions:1. Prof. Shen’s academic thoughts of syndrome differentiation and treatment of CAG come from the Huangdi Neijing, absorbing the thoughts and characteristics of medicine usage of many ancient medical experts such as Zhang Zhongjing, Li Dongyuan, Ye Tianshi and so on, and obtaining the guidance of the elder Chinese medicine expert-- Professor He Lun, and establish his own unique syndrome differentiation thinking features and clinical medication.2. Prof. Shen puts forward "a pathogenesis theory of co-existence of deficiency and stagnation" and "the deficiency and excess correlation syndrome", advocates combined utilization of flourishing deficiency and dredging stagnation, and emphasizes enriching stomach-yin to harmonize stomach qi; Prof. Shen raises a core pathogenesis theory of toxin congestion of PLGC and stresses the mutual assistance of absorption and digestion of spleen and stomach, comprehensive use of ascending and descending, interdependence between drying and moistening, and the treatments are flexible.3. The conclusions of data mining research on precancerous lesion of atrophic gastritis:syndrome structures of PLGC are mainly the deficiency and excess correlation syndrome; the research proposes that the core pathogenesis of PLGC is toxin congestion and deficiency of both yin and qi; the principal treatment of PLGC is to detoxify and remove blood stasis and tonify qi and nourish yin; The medicine applied in the clinical treatment of PLGC is mainly these being characterized by tonifying qi and nourishing yin and removing toxic factors and stagnation; data mining research of 120 PLGC cases can practically reflect the features of clinical thinking and the rule of prescription of Prof. Shen in treating PLGC as well as its scientificity. Building Unitized Clinical Medical Records Management System of Famous TCM Doctor’s Syndrome Differentiation is successfully applied in clinical practice, which helpfully explore the heritage of famous elder TCM doctor’s academic and clinical experience.The Innovation of This Study:1. This study arranges Prof. Shen’s clinical experience and academic thoughts of syndrome differentiation and treatment of the CAG systematically.2. To study the experience of Prof. Shen’s clinical cases about the treatment of PLGC by data mining method, in the process of building Unitized Clinical Medical Records Management System of Famous TCM Doctor’s Syndrome Differentiation (acquired computer software copyright register certificate of the national copyright administration of the People’s Republic of China on March 19,2015:No.0935887) databank, the study picks up the four diagnostic data based on location of disease, nature of disease, tendency of disease, etc, conceals unitized syndrome differentiation in the data, and reflects the scientific connotation including clinical thinking, medication frequency and evaluation of treatment effect in the treatment of PLGC and its innovation. |
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